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General NPI Number Information
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NPI Number | 1275167280
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Entity Type | Individual
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Provider Name | SAMANTHA B NELSON M.ED., BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 2100 LIBERTY RD
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City | LEXINGTON
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State | KY
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Zip | 40509-4319
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Country | US
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Telephone | 859-447-2309
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 RED STONE DR
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City | LEXINGTON
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State | KY
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Zip | 40509-2332
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133003441
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 273595
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License Number State | KY
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